Healthcare Provider Details

I. General information

NPI: 1902896392
Provider Name (Legal Business Name): EVANGELINA BERRIOS COLON PHARMD, CACP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 05/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2090 ADAM CLAYTON POWELL JR BLVD
NEW YORK NY
10027-4990
US

IV. Provider business mailing address

1924 77TH ST
EAST ELMHURST NY
11370-1207
US

V. Phone/Fax

Practice location:
  • Phone: 212-851-1192
  • Fax:
Mailing address:
  • Phone: 646-286-1794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number048754I
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: